SPORT INJURY M ANAGEMENT Volume I
Sports Injury Management: Volume I
Table of Contents Osg Osgood-Sc -Schlat hlatte terr Dise Diseas asee (OS (OSD) 5 Patellar e endinitis 9 Is Yo Your Ga Game Ha Hamstrung? 17 17 Sports Injury Management Volume I
Ilio Ilioti tibbial ial Ban Band Fri Frict ctiion Syn Syndr droome 25 Musculoskeletal Musculoskeletal Consumer Review A diision of Core Concepts Pte Ltd 73 ras Street, #02-01 Singapore 079012
Articles originally appeared in mcr.coreconcepts.com.sg
All rights reserved No part o this book shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission rom the publisher No patent liability is assumed with respect to the use o the inormation contained herein herein Although every precaution precaution has been taken in the preparation o this book, the publisher and author assume no responsibility responsibility or errors or omissions Nor is any liability assumed or damages resulting rom the use o the inormation contained herein Copyright 2008 Core Concepts Pte Ltd Artworks/Images: iStockPhoto
Te Bu Buckling Kn Knee 29 29 Snapping An Ank le 35 35 Sports Injury Management: Volume I is a collection o articles written by Back2Sports’ specialist physiothera physiothera- pists Te benets o sports is tremendous and should not be hampered by injuries that could have been pre vented I not prevented then better managed to enable a quick return to sports
Education Education plays an important role in managing ma naging this potential injuries We hope that this collection o articles will be able to contribute contribute in some small way in urthering our better understanding our sports injuries and how to prevent and manage them better Back2Sports eam
Sports Injury Management: Volume I
Osgood-Schlatter Disease (OSD) Osgood-Schlatter Osgood-Schlatter Disease is most commonly characterized by the big tibial tubercle and pain on activities like kneeling or repeated jumping OSD arises rom a strong pull o the quadriceps muscle on the tibial tubercle during a child’s growth spurt Tis normally occurs around the ages o 9 – 16 years old Tis strong pull occurs in sports that require a quick, strong contraction o the quadriceps, like in soccer, martial arts, and basketball Te quick, strong pull on the tibial tubercle has an avulsion-racture avulsion-rac ture like eect (when a small bone ragment breaks away rom the main bone mass) that would cause an inammation o the periostium However, with the child being actively involved with the sport, this eect is magnied as the t he action is repeated Te requency and repetitive nature o
Sports Injury Management: Volume I
Osgood-Schlatter Disease (OSD) Osgood-Schlatter Osgood-Schlatter Disease is most commonly characterized by the big tibial tubercle and pain on activities like kneeling or repeated jumping OSD arises rom a strong pull o the quadriceps muscle on the tibial tubercle during a child’s growth spurt Tis normally occurs around the ages o 9 – 16 years old Tis strong pull occurs in sports that require a quick, strong contraction o the quadriceps, like in soccer, martial arts, and basketball Te quick, strong pull on the tibial tubercle has an avulsion-racture avulsion-rac ture like eect (when a small bone ragment breaks away rom the main bone mass) that would cause an inammation o the periostium However, with the child being actively involved with the sport, this eect is magnied as the t he action is repeated Te requency and repetitive nature o
Sports Injury Management: Volume I
it would also cause a lot o inconveniences later on in their growing years
Tibial Tuberosity
Management
Tuberosity Tuberosity refers to round elevation (bump) from the bone
•
Patella (Knee cap)
•
Patellar Tendon
•
• Tibial Tuberosity front view
• side view
source: visiblebody & core concepts
the sport doesn’t allow the periostium to recover and thus causes a chronic inammation on the prominence o the tubercle (see image) Tis leads to a constant, constant, persistent pain, especially on impact i mpact Tis pain will not only limit the child’s perormance in the sport, preventing them rom excelling,
RICER regime (Rest, Ice, Compression, Elevation, and Reerral) Oral NSAIDs NSAIDs or injection injection o o NSAIDs NSAIDs directly over the painul area Ultrasound guided Extracorporeal Shock Wave herapy (ESW) by a sports physician to break down scarred tissues and allow al low or the tubercle to heal Stretches and improving muscle control through physiotherapy Assessing or biomechanical biomechanical actors actors that may may cause OSD by sports physiotherapists to pre vent recurrence o pain and to maximise the child’s perormance in their sport
Prevention Te best way to prevent the onset o OSD is to ensure adequate stretching and good control o the quadriceps Adequate prehab should thus be a key beore starting any orm o sport
Sports Injury Management: Volume I
it would also cause a lot o inconveniences later on in their growing years
Tibial Tuberosity
Management
Tuberosity Tuberosity refers to round elevation (bump) from the bone
•
Patella (Knee cap)
•
Patellar Tendon
•
• Tibial Tuberosity front view
• side view
source: visiblebody & core concepts
the sport doesn’t allow the periostium to recover and thus causes a chronic inammation on the prominence o the tubercle (see image) Tis leads to a constant, constant, persistent pain, especially on impact i mpact Tis pain will not only limit the child’s perormance in the sport, preventing them rom excelling,
RICER regime (Rest, Ice, Compression, Elevation, and Reerral) Oral NSAIDs NSAIDs or injection injection o o NSAIDs NSAIDs directly over the painul area Ultrasound guided Extracorporeal Shock Wave herapy (ESW) by a sports physician to break down scarred tissues and allow al low or the tubercle to heal Stretches and improving muscle control through physiotherapy Assessing or biomechanical biomechanical actors actors that may may cause OSD by sports physiotherapists to pre vent recurrence o pain and to maximise the child’s perormance in their sport
Prevention Te best way to prevent the onset o OSD is to ensure adequate stretching and good control o the quadriceps Adequate prehab should thus be a key beore starting any orm o sport
Sports Injury Management: Volume I
Patellar endinitis Patellar tendinitis or ‘jumpers knee’ is a condition that results rom an inammation o the patellar tendon Te patellar tendon is the structure that connects the t he patella (knee cap) to the tibia (shin bone) bone) aki aking ng a closer look at anatomy, a natomy, the knee cap is a small oating bone (sesamoid) which attaches the quadriceps to the tibia through the patellar tendon Hence the patellar tendon being a continuation o the bulky quadriceps quadriceps muscle is pivotal in the t he way you move your leg It helps the quadriceps muscle extend the lower leg so that you can kick a ball, jump in air or push the pedals on your bike Te symptoms o patellar tendinitis are pain and occasionally a swelling over the patellar tendon Pain is usually sharp during the sporting activities such as jumping or running and persists as a dull
Sports Injury Management: Volume I
Patellar endinitis Patellar tendinitis or ‘jumpers knee’ is a condition that results rom an inammation o the patellar tendon Te patellar tendon is the structure that connects the t he patella (knee cap) to the tibia (shin bone) bone) aki aking ng a closer look at anatomy, a natomy, the knee cap is a small oating bone (sesamoid) which attaches the quadriceps to the tibia through the patellar tendon Hence the patellar tendon being a continuation o the bulky quadriceps quadriceps muscle is pivotal in the t he way you move your leg It helps the quadriceps muscle extend the lower leg so that you can kick a ball, jump in air or push the pedals on your bike Te symptoms o patellar tendinitis are pain and occasionally a swelling over the patellar tendon Pain is usually sharp during the sporting activities such as jumping or running and persists as a dull
Sports Injury Management: Volume I
ache aer the activity Initially the pain might be present only during the start or aer completing the sport or work out which then worsens to becoming more constant in nature Everyday activities such as climbing up and down stairs might be painul too Pain on pressing directly over the patellar tendon is a characteristic eature in examination An X-ray might provide additional inormation o a bone spur and an MRI is needed in more chronic cases to rule out tendon degeneration Te commonest cause o patellar tendinitis is overuse Tis occurs requently in jumping sports such as basketball and a nd volleyball and hence it is oen reerred to as ‘jumpers knee’ However it can occur with sports such as running and soccer too A less common cause is due to direct injury to the tendon Te inammation can be a result o numerous actors Here are some o the causes which lead to patellar tendinitis:
Factors
Causes
rain rainin ingg Erro Errors rs
• Rapid Rapid incr increa ease se in the the rerequency quency o training • Sudden increase in the intensity o training • ransition rom one sport to another without proper conditioning • Repeated training on a rigid surace, leading to high impact • Lack o lexibility exerexercises • A poor base strength o o the quadriceps muscle
Sports Injury Management: Volume I
ache aer the activity Initially the pain might be present only during the start or aer completing the sport or work out which then worsens to becoming more constant in nature Everyday activities such as climbing up and down stairs might be painul too Pain on pressing directly over the patellar tendon is a characteristic eature in examination An X-ray might provide additional inormation o a bone spur and an MRI is needed in more chronic cases to rule out tendon degeneration
Factors
Causes
rain rainin ingg Erro Errors rs
• Rapid Rapid incr increa ease se in the the rerequency quency o training • Sudden increase in the intensity o training • ransition rom one sport to another without proper conditioning
Te commonest cause o patellar tendinitis is overuse Tis occurs requently in jumping sports such as basketball and a nd volleyball and hence it is oen reerred to as ‘jumpers knee’ However it can occur with sports such as running and soccer too A less common cause is due to direct injury to the tendon
• Repeated training on a rigid surace, leading to high impact • Lack o lexibility exerexercises • A poor base strength o o the quadriceps muscle
Te inammation can be a result o numerous actors Here are some o the causes which lead to patellar tendinitis:
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Sports Injury Management: Volume I
Factors
Causes
Biomechanical Factors
• Reduced lexibility o the thigh muscles namely the quadriceps and the hamstring muscles • Muscle imbalance, imbalanc e, i some muscles in your leg are much stronger than others
Treatment Options
Rest
Correcting Body Mechanics
• Patella alta, a condition in which the knee cap is structurally much higher than the knee joint
reatment o patellar tendinitis is usually conservative, and is briey discussed below:
• No Not necessarily meaning to stop all activities but only those that involve straining the patellar tendon ie Jumping and running • Stretching tight thigh muscles to equalize orce distribution in the leg muscles • Strengthening the quadriceps muscle, particularly in an eccentric ashion
• Overweight • Foot conditions, conditions , either a lat oot or a raised arch can impose high strain on the patellar tendon
Details
Patellar endon Strap
• Proper orm in take o and landing techniques in sport • Strapping or taping techniques might help take o pressure rom the patellar tendon and help in urther aggravation as well as pain relie
Sports Injury Management: Volume I
Factors
Causes
Biomechanical Factors
• Reduced lexibility o the thigh muscles namely the quadriceps and the hamstring muscles • Muscle imbalance, imbalanc e, i some muscles in your leg are much stronger than others
Treatment Options
Details
Rest
Correcting Body Mechanics
• Patella alta, a condition in which the knee cap is structurally much higher than the knee joint
• Strengthening the quadriceps muscle, particularly in an eccentric ashion
• Overweight • Foot conditions, conditions , either a lat oot or a raised arch can impose high strain on the patellar tendon reatment o patellar tendinitis is usually conservative, and is briey discussed below:
• No Not necessarily meaning to stop all activities but only those that involve straining the patellar tendon ie Jumping and running • Stretching tight thigh muscles to equalize orce distribution in the leg muscles
Patellar endon Strap
• Proper orm in take o and landing techniques in sport • Strapping or taping techniques might help take o pressure rom the patellar tendon and help in urther aggravation as well as pain relie
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Sports Injury Management: Volume I
Treatment Options
Orthotics
Additional Additional Ap proaches
Details
• Foot orthotics to support the arch or better shock absorption in jumping and other impact sport • other physiotherapy treatments such as ultrasound and, laser might help in pain relie during the acute phase o healing • extracorporeal extracorporea l shock wave therapy using sound waves to heal the tendon • medications such as NSAIDS and corticosteroids are used to settle the initial acute healing phase
Patellar Tendon Knee-cap (Patellar)
Patellar Tendon
Quadriceps Muscles connected to the knee-cap
source: visiblebody visiblebody & core concepts
I the symptoms persists beyond 6 months aer attempting conservative treatment then surgery can be discussed Tere is little research available on the best surgical options or patellar tendinitis so the procedure depends largely on the surgeons discretion
Sports Injury Management: Volume I
Treatment Options
Orthotics
Additional Additional Ap proaches
Details
• Foot orthotics to support the arch or better shock absorption in jumping and other impact sport • other physiotherapy treatments such as ultrasound and, laser might help in pain relie during the acute phase o healing • extracorporeal extracorporea l shock wave therapy using sound waves to heal the tendon • medications such as NSAIDS and corticosteroids are used to settle the initial acute healing phase
Patellar Tendon Knee-cap (Patellar)
Patellar Tendon
Quadriceps Muscles connected to the knee-cap
source: visiblebody visiblebody & core concepts
I the symptoms persists beyond 6 months aer attempting conservative treatment then surgery can be discussed Tere is little research available on the best surgical options or patellar tendinitis so the procedure depends largely on the surgeons discretion
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Sports Injury Management: Volume I
Is Your Game Hamstrung? Basketball players tend to ocus a lot on the quadriceps (muscles in ront o the thigh) when doing strength training oen neglecting the hamstrings Tis severe muscle strength imbalance oten leads to hamstring pulls or tears And A nd just as im portantly, portantly, players with weak hamstrings also simply don’t play as well as shown in a study o national basketball teams
Why focus on the hamstring? In a study amongst national basketball team divisions, division I players have signicantly higher peak torque (explosive power) than the lower divisions in both the quads and hamstrings Running ast is not simply a result o the legs pushing o the oor with the quads; but also the result o the hamstring and the glutes pulling back the hips Explosive power power rom both the quads and the hamstrings are crucial to high hig h perormance plays plays
Sports Injury Management: Volume I
Is Your Game Hamstrung? Basketball players tend to ocus a lot on the quadriceps (muscles in ront o the thigh) when doing strength training oen neglecting the hamstrings Tis severe muscle strength imbalance oten leads to hamstring pulls or tears And A nd just as im portantly, portantly, players with weak hamstrings also simply don’t play as well as shown in a study o national basketball teams
Why focus on the hamstring? In a study amongst national basketball team divisions, division I players have signicantly higher peak torque (explosive power) than the lower divisions in both the quads and hamstrings Running ast is not simply a result o the legs pushing o the oor with the quads; but also the result o the hamstring and the glutes pulling back the hips Explosive power power rom both the quads and the hamstrings are crucial to high hig h perormance plays plays
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Sports Injury Management: Volume I
Hamstrings Te hamstring is a group o large, powerul muscles that covers covers the back o the t he thigh, rom the lower pelvis to the back o the shin bone Te hamstring unctions to extend the hip joint and ex the knee joint I the quadriceps is ar stronger than the hamstrings, it can easily overpower overpower the hamstrings, tearing or straining strai ning them during vigorous game play Sadly, hamstring pulls rank high amongst the most common injuries to bench a player Just recently in April, Forward Luke Walton missed the Lakers’ game at Sacramento with a strained right hamstring
4 Diiculty in contracting contracting the muscle or lexing the knee 5 Pain on walking walk ing especially upslope and sprintsprinting Some immediate steps to take include applying RICER (Rest Ice Compression Elevation and Reerral) Seek a doctor or physiotherapist’s attention i you have difculty walking or the pain is quite signicant
Hamstring Exercise r a l u t e n N e i n i S p e p e K
Are you hamstrung? Common symptoms o a pulled hamstring include : 1 Bruising Bruisi ng rom small muscle tear and bleeding, 2 Swelling, 3 Muscle spasm and, Starting Position
Lowering Movement
Sports Injury Management: Volume I
Hamstrings Te hamstring is a group o large, powerul muscles that covers covers the back o the t he thigh, rom the lower pelvis to the back o the shin bone Te hamstring unctions to extend the hip joint and ex the knee joint I the quadriceps is ar stronger than the hamstrings, it can easily overpower overpower the hamstrings, tearing or straining strai ning them during vigorous game play Sadly, hamstring pulls rank high amongst the most common injuries to bench a player Just recently in April, Forward Luke Walton missed the Lakers’ game at Sacramento with a strained right hamstring
4 Diiculty in contracting contracting the muscle or lexing the knee 5 Pain on walking walk ing especially upslope and sprintsprinting Some immediate steps to take include applying RICER (Rest Ice Compression Elevation and Reerral) Seek a doctor or physiotherapist’s attention i you have difculty walking or the pain is quite signicant
Hamstring Exercise r a l u t e n N e i n i S p e p e K
Are you hamstrung? Common symptoms o a pulled hamstring include : 1 Bruising Bruisi ng rom small muscle tear and bleeding, 2 Swelling, 3 Muscle spasm and, Starting Position
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Sports Injury Management The rst 72 hours - what to do est the injured area for 48-72 hours. Movement of the injured part will increase blood ow and bleeding to the injur y site, may cause the blood clot to dislodge, and begin bleeding again and may cause more tissue damage. ce. Apply ice or cold therapy to injured area area for 15-20minutes 15-20minutes every two hours. Avoid direct ice contact to the skin to prevent cold burns. Ice decreases swelling and pain. ompression. Apply rm, elastic, non-adhesive bandage to the area. May be done in conjunction as an ice compress. Reduces swelling and bleeding at the injury site. levate the injured area above the heart level. For example for an ankle injury, when lying down, raise the ankle slightly above the body with pillow. Elevation decreases bleeding, swelling and pain. efer to see a doctor or physiotherapist physiotherapist for an accurate denitive diagnosis. You may need continued management (including anti-inammatory medication) and prescription of a rehabilitation programme.
Lowering Movement
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Sports Injury Management: Volume I
Sports Injury Management: Volume I
Sports Injury Management The rst 72 hours - what to do est the injured area for 48-72 hours. Movement of the injured part will increase blood ow and bleeding to the injur y site, may cause the blood clot to dislodge, and begin bleeding again and may cause more tissue damage. ce. Apply ice or cold therapy to injured area area for 15-20minutes 15-20minutes every two hours. Avoid direct ice contact to the skin to prevent cold burns. Ice decreases swelling and pain. ompression. Apply rm, elastic, non-adhesive bandage to the area. May be done in conjunction as an ice compress. Reduces swelling and bleeding at the injury site. levate the injured area above the heart level. For example for an ankle injury, when lying down, raise the ankle slightly above the body with pillow. Elevation decreases bleeding, swelling and pain. efer to see a doctor or physiotherapist physiotherapist for an accurate denitive diagnosis. You may need continued management (including anti-inammatory medication) and prescription of a rehabilitation programme.
www.Back2Sports.com.sg
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Sports Injury Management: Volume I
very hard to get you back up Watch or excessive movements rom the back I you eel your back muscles tightening up much and starts to ache, you could be using your back extensor muscles to compensate
Hamstring of Steel Tis exercise is great to build up really strong hamstrings Start position • Place your your knees on the glute-ham bench with your ankles irmly supported and assume an upright position, with hips and shoulders in line with knees I you don’t a bench, work with a partner to hold your eet down
• ighten your your buttocks buttocks and tuck your tummy in so your pelvis is in the neutral position Lowering movement • Slowly lower your whole whole body orward until you eel a pull in your hamstrings
• Squeezing your buttocks throughout the movement to keep your hips extended • Stop when when you eel a little strain in the hamstrings Return movement • Pause or moment and raise your body back to the start position Your hamstrings will work
o make it easier to start with, bend at the hips a little or use your hands to help you back up at rst As A s you get stronger, stronger, you will be able to complete the movement up and down smoothly I at rst you cannot lean very ar orward, this will also improve with practice Aim to get as ar a r orward as possible to work the hamstrings through a ull u ll range o motion Perorm two sets o ve reps at rst, building up the range o motion Once you can complete a ull range all the way down and up, keeping your body straight, increase to three sets o 8-10 reps Don’t orget to do sprint work to build up the explosive strength strength o your hamstring A nd lastly stretch them out L onger hamstrings produce more explosive power Reerence: 1
Peak torque torque o quadriceps and hamstring muscles in basketball and soccer players o dierent divisions, Journal o Sports Medicine and Physical Fitness, 1995
Sports Injury Management: Volume I
very hard to get you back up Watch or excessive movements rom the back I you eel your back muscles tightening up much and starts to ache, you could be using your back extensor muscles to compensate
Hamstring of Steel Tis exercise is great to build up really strong hamstrings Start position • Place your your knees on the glute-ham bench with your ankles irmly supported and assume an upright position, with hips and shoulders in line with knees I you don’t a bench, work with a partner to hold your eet down
• ighten your your buttocks buttocks and tuck your tummy in so your pelvis is in the neutral position Lowering movement • Slowly lower your whole whole body orward until you eel a pull in your hamstrings
• Squeezing your buttocks throughout the movement to keep your hips extended • Stop when when you eel a little strain in the hamstrings Return movement • Pause or moment and raise your body back to the start position Your hamstrings will work
o make it easier to start with, bend at the hips a little or use your hands to help you back up at rst As A s you get stronger, stronger, you will be able to complete the movement up and down smoothly I at rst you cannot lean very ar orward, this will also improve with practice Aim to get as ar a r orward as possible to work the hamstrings through a ull u ll range o motion Perorm two sets o ve reps at rst, building up the range o motion Once you can complete a ull range all the way down and up, keeping your body straight, increase to three sets o 8-10 reps Don’t orget to do sprint work to build up the explosive strength strength o your hamstring A nd lastly stretch them out L onger hamstrings produce more explosive power Reerence: 1
Peak torque torque o quadriceps and hamstring muscles in basketball and soccer players o dierent divisions, Journal o Sports Medicine and Physical Fitness, 1995
Sports Injury Management: Volume I
Iliotibial Band Friction Syndrome Tell any long-distance runner or cyclist about your stinging pain at the side o the knee or hip, and you will get a knowing sympathetic look IB (Iliotibial band) riction syndrome is one o the commonest complaints amongst runners, cyclists and inten i ntense se court sports IB riction syndrome gets its name rom the Iliotibial Band rubbing against a bony protrusion just at the side your knee Te IB is a continuation o one the largest hip muscles and spans as a thick band o tissue on the outside o the thigh Starting rom the pelvis, it runs over side o the hip and ending just below the knee Just beore it crosses the knee, it runs over a protrusion in the thigh bone (lateral emoral epicondyle) Te requent rubbing o the band over this bony protrusion rom bending and straightening o the knee irritates the band, causing an inammation Te tighter the IB, the harder it
Sports Injury Management: Volume I
Iliotibial Band Friction Syndrome Tell any long-distance runner or cyclist about your stinging pain at the side o the knee or hip, and you will get a knowing sympathetic look IB (Iliotibial band) riction syndrome is one o the commonest complaints amongst runners, cyclists and inten i ntense se court sports IB riction syndrome gets its name rom the Iliotibial Band rubbing against a bony protrusion just at the side your knee Te IB is a continuation o one the largest hip muscles and spans as a thick band o tissue on the outside o the thigh Starting rom the pelvis, it runs over side o the hip and ending just below the knee Just beore it crosses the knee, it runs over a protrusion in the thigh bone (lateral emoral epicondyle) Te requent rubbing o the band over this bony protrusion rom bending and straightening o the knee irritates the band, causing an inammation Te tighter the IB, the harder it
Sports Injury Management: Volume I
ITB: Bony Protrusion ITB snaps over protrustion lateral femoral epicondyle (protrusion)
Irritated ITB
Knee-cap
source: visiblebody & core concepts
rubs over the protrusion
What tightens the ITB? Tree basic things tighten the IB 1. Training Methods
Running on banked suraces, inadequate warm up or cool down, increases in distance too ast or excessive downhill running are aults associated with running which strains strains the IB In cycling having having the eet toed inwards commonly causes the band to get tight 2. Bio-mechanical Gait Problems with oot structures such as high or low arches and uneven leg length typically tighten the IB on one side A complete biomechanical assessment helps determine the aults Where appropriate, oot orthotics can correct these problems 3. Weak outer hip muscles Weak outer hip muscles orces the IB to work harder to compensate and becomes tight as a result Exercise to strengthen the outer hip muscles helps to lighten the load on the IB
Despite avoiding all the three issues mentioned, athletes with a high training volume oen still ex perience painul IBs In such cases, deep tissue massage will help release release the tight band Don’t orget to stretch the IB Ignoring IB tightness can lead to groin pain and low back pains
Sports Injury Management: Volume I
ITB: Bony Protrusion ITB snaps over protrustion lateral femoral epicondyle (protrusion)
Irritated ITB
Knee-cap
source: visiblebody & core concepts
rubs over the protrusion
What tightens the ITB? Tree basic things tighten the IB 1. Training Methods
Running on banked suraces, inadequate warm up or cool down, increases in distance too ast or excessive downhill running are aults associated with running which strains strains the IB In cycling having having the eet toed inwards commonly causes the band to get tight 2. Bio-mechanical Gait Problems with oot structures such as high or low arches and uneven leg length typically tighten the IB on one side A complete biomechanical assessment helps determine the aults Where appropriate, oot orthotics can correct these problems 3. Weak outer hip muscles Weak outer hip muscles orces the IB to work harder to compensate and becomes tight as a result Exercise to strengthen the outer hip muscles helps to lighten the load on the IB
Despite avoiding all the three issues mentioned, athletes with a high training volume oen still ex perience painul IBs In such cases, deep tissue massage will help release release the tight band Don’t orget to stretch the IB Ignoring IB tightness can lead to groin pain and low back pains
Sports Injury Management: Volume I
Te Buckling Knee
Having a sense o the knee ‘giving way’ or ‘ locklock-
ing’ is a airly common complaint by athletes who have twisted their knees in sports like basketball, netball, soccer or badminton Te sensation o ‘giving way’ is an indication that you might have torn your Anterior Cruciate Ligament (ACL) while the ‘locking’ sensation is an indication o a possible meniscus tear
ACL ACL Injury Injur y Te ACL is a airly strong ligament ound between the knee-joint Its main role is to limit the orward movement (anterior translation) o the leg bone (tibia) on the thigh bone (emur)
Sports Injury Management: Volume I
Te Buckling Knee
Having a sense o the knee ‘giving way’ or ‘ locklocking’ is a airly common complaint by athletes who have twisted their knees in sports like basketball, netball, soccer or badminton Te sensation o ‘giving way’ is an indication that you might have torn your Anterior Cruciate Ligament (ACL) while the ‘locking’ sensation is an indication o a possible meniscus tear
ACL ACL Injury Injur y Te ACL is a airly strong ligament ound between the knee-joint Its main role is to limit the orward movement (anterior translation) o the leg bone (tibia) on the thigh bone (emur)
Sports Injury Management: Volume I
Lateral View of the Knee
When athletes change direction quickly during their games, they twist their knee inwards Tis increases the strain on the ACL and places the ligament at risk o tearing Te ACL tears when the knee is orce downwards and inwards beyond the ligament’s ability to hold Athletes who tear their ACL oen report hearing a ‘pop’ on injury Unortunately, the ACL is very rarely the only ligament involved in this kind o injury It is normally accompanied with a slight tear in the Medial Collateral Ligament (MCL) and either a medial or lateral meniscus (cartilage) tear Tese three tears are commonly known as the ‘Unhappy riad’ or ‘errible riad’
Meniscal Injury
source: US GSA & core concepts
Te meniscus, which is a crescent shaped cartilage between the knee, acts as a cushion to absorb the impact between the leg and thigh t high bone Te meniscus is better at the handling stress rom an up and down motion It doesn’t do as well under a twisting motion especially when compressed Tis motion can cause a tear in the meniscus Te knee eels ‘locked’ when the torn part o the meniscus blocks the movement o the knee
Sports Injury Management: Volume I
Lateral View of the Knee
When athletes change direction quickly during their games, they twist their knee inwards Tis increases the strain on the ACL and places the ligament at risk o tearing Te ACL tears when the knee is orce downwards and inwards beyond the ligament’s ability to hold Athletes who tear their ACL oen report hearing a ‘pop’ on injury Unortunately, the ACL is very rarely the only ligament involved in this kind o injury It is normally accompanied with a slight tear in the Medial Collateral Ligament (MCL) and either a medial or lateral meniscus (cartilage) tear Tese three tears are commonly known as the ‘Unhappy riad’ or ‘errible riad’
Meniscal Injury
source: US GSA & core concepts
Te meniscus, which is a crescent shaped cartilage between the knee, acts as a cushion to absorb the impact between the leg and thigh t high bone Te meniscus is better at the handling stress rom an up and down motion It doesn’t do as well under a twisting motion especially when compressed Tis motion can cause a tear in the meniscus Te knee eels ‘locked’ when the torn part o the meniscus blocks the movement o the knee
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• Gluteus Medius Immediate swelling and severe pain in the knee are common signs o this riad injury However, there are occasions where there will be a delay in the onset o swelling or even no swelling at all Remember how you injured the knee It helps your Doctor or Physiotherapist in diagnosing this problem
Solving the Problem Problem Sadly, the ACL doesn’t heal on its own due to the t he poor blood supply to the ligament It would need to be reconstructed constructed surgically by using either your hamstring tendon or patella tendon Rehabilitation aer surgery normally takes about 6-9 months beore the athlete is able to go back to ull training Nevertheless, there t here are about 20% o people with ACL tears who are able to go about their day-to-day activities without having their ACL reconstructed reconstructed o cope without surgery, the ollowing muscles need to have good strength and control: • Hamstrings • Quadriceps (thigh)
• Gastrocneumius Gastrocneumius (cal (cal ) Besides doing strengthening exercises, slowly getting back into sports specic training is essential Tis is so that your muscles can develop an anticipatory reaction (eed-orward mechanism) to prevent injury Sports taping o the knee to support the ACL and MCL can also be done as a temporary measure or the athlete to cope with the injury until the t he end o the season
Sports Injury Management: Volume I
• Gluteus Medius Immediate swelling and severe pain in the knee are common signs o this riad injury However, there are occasions where there will be a delay in the onset o swelling or even no swelling at all Remember how you injured the knee It helps your Doctor or Physiotherapist in diagnosing this problem
Solving the Problem Problem Sadly, the ACL doesn’t heal on its own due to the t he poor blood supply to the ligament It would need to be reconstructed constructed surgically by using either your hamstring tendon or patella tendon Rehabilitation aer surgery normally takes about 6-9 months beore the athlete is able to go back to ull training
• Gastrocneumius Gastrocneumius (cal (cal ) Besides doing strengthening exercises, slowly getting back into sports specic training is essential Tis is so that your muscles can develop an anticipatory reaction (eed-orward mechanism) to prevent injury Sports taping o the knee to support the ACL and MCL can also be done as a temporary measure or the athlete to cope with the injury until the t he end o the season
Nevertheless, there t here are about 20% o people with ACL tears who are able to go about their day-to-day activities without having their ACL reconstructed reconstructed o cope without surgery, the ollowing muscles need to have good strength and control: • Hamstrings • Quadriceps (thigh)
Sports Injury Management: Volume I
Snapping Ankle
In people who recurrently sprain their ankle, it is not uncommon to hear clicking coming rom the outside o their ankle Tis phenomenon is commonly known as “snapping” ankle or slipping peroneal peroneal tendon tendon As the name suggests, the clicking clicki ng sound arises rom the peroneal tendons slipping in and out o the groove behind the bone sticking out on the outside o the ankle Medically, it’s known as peroneal subluxation
Anatomy Te peroneal muscles are made o 2 muscles and lie on the outside o the ankle Tey assist in pointing the oot downwards and outwards Tese two muscles run through a groove behind the lateral lateral malleolus and are kept within the groove by a sheath Tis complex is then re-enorced by a ligament-like structure known as a rectinaculum, preventing the
Sports Injury Management: Volume I
Snapping Ankle
In people who recurrently sprain their ankle, it is not uncommon to hear clicking coming rom the outside o their ankle Tis phenomenon is commonly known as “snapping” ankle or slipping peroneal peroneal tendon tendon As the name suggests, the clicking clicki ng sound arises rom the peroneal tendons slipping in and out o the groove behind the bone sticking out on the outside o the ankle Medically, it’s known as peroneal subluxation
Anatomy Te peroneal muscles are made o 2 muscles and lie on the outside o the ankle Tey assist in pointing the oot downwards and outwards Tese two muscles run through a groove behind the lateral lateral malleolus and are kept within the groove by a sheath Tis complex is then re-enorced by a ligament-like structure known as a rectinaculum, preventing the
Sports Injury Management: Volume I
tendon rom slipping out o the groove
Why do I get this problem? When you roll your ankle outwards, it may put the peroneal tendons on a orceul stretch Tis orceul stretch may cause tears in the rectinaculum Frequent sprains would thus increase the strain on the rectinaculum, which ultimately might cause the rectinaculum to tear Tis tear in the rectinaculum compromises the integrity o complex, allowing the tendon to slip in and out o groove However, in some cases, there is a structural deect that causes the slipping Tere are some people born with a shallow groove and thus gives rise to the slip ping
SNAPPING ANKLE Peroneus longus muscle Peroneus brevis muscle
Lateral malleolus (bony protrusion at the side of ankle)
The ankle ‘snaps’ when the peroneal tendon slips out of the groove behind the lateral malleolus
Diagnosis and Management Peroneal tendons
Diagnosing a peroneal subluxation is normally overlooked as this problem is commonly superseded with other more acute pain o an ank le sprain, like swelling arising rom an AFL strain Diagnosing this problem requires a close examination o the ankle An experienced Sports Physician, Orthopedic Surgeon or Sports Physiotherapist would normally
source: visiblebody & core concepts
assess the ankle in all ranges to check whether the tendon would slip out Another common test would be a resisted up pointing and out turning o the ankle Tis could cause the tendon to thicken and slip out o the groove and can be elt at the back o the
Sports Injury Management: Volume I
tendon rom slipping out o the groove
Why do I get this problem? When you roll your ankle outwards, it may put the peroneal tendons on a orceul stretch Tis orceul stretch may cause tears in the rectinaculum Frequent sprains would thus increase the strain on the rectinaculum, which ultimately might cause the rectinaculum to tear Tis tear in the rectinaculum compromises the integrity o complex, allowing the tendon to slip in and out o groove However, in some cases, there is a structural deect that causes the slipping Tere are some people born with a shallow groove and thus gives rise to the slip ping
SNAPPING ANKLE Peroneus longus muscle Peroneus brevis muscle
Lateral malleolus (bony protrusion at the side of ankle)
The ankle ‘snaps’ when the peroneal tendon slips out of the groove behind the lateral malleolus
Diagnosis and Management Peroneal tendons
Diagnosing a peroneal subluxation is normally overlooked as this problem is commonly superseded with other more acute pain o an ank le sprain, like swelling arising rom an AFL strain Diagnosing this problem requires a close examination o the ankle An experienced Sports Physician, Orthopedic Surgeon or Sports Physiotherapist would normally
source: visiblebody & core concepts
assess the ankle in all ranges to check whether the tendon would slip out Another common test would be a resisted up pointing and out turning o the ankle Tis could cause the tendon to thicken and slip out o the groove and can be elt at the back o the
Sports Injury Management: Volume I
lateral malleolus Pain, tenderness and swelling may also be seen over the tendon behind the rectinaculum Te rst choice o management or a peroneal subluxation is a reerral to physiotherapy or rehabilitation In acute stages, the aim is to prevent urther aggravation to the strain on the rectinaculum and a cast might be used or the rst 4-6 weeks During that period, gentle stretching o the tendon and range o movement is advised to prevent stiening o the ankle an kle Ultrasound and cryotherapy may also be used to help manage the pain and swelling i present Following the protective phase, proprioceptive training and eccentric strengthening exercises o the peroneal tendons are essential in prevention o a recurrence However, 50% o acute subluxation tends to recur in active athletes Tis would normally normally result in either surgery or a retirement rom the sport Tere are 3 common surgical techniques: • Rectinaculum Repair
• Groove Reconstruction • Construction o o a bony block Following surgery, physiotherapy will be essential to get you back to sport
Post-surgical Management An immobilization period varying rom 3-6 weeks will ollow aer surgery Upon removal o the cast, achieving a ull range o movement o your ankle will be the main goal o rehabilitation in the rst 4 weeks Pain controlling controlling modalities like ultrasound and ENS may be used i pain is present Building up the strength and proprioception o the ankle with exercises like cal raises and single leg stand (eyes open/ eyes closed) would normally start about the same time Progressing proprioceptive training rom standing on stable ground to a rocker board, ollowed by a wobble board is a normal progression beore proceeding proceeding to agility drills Only when one achieves ull range o movement, good strength and ability to complete sports specic agility drills will one be allowed to return to sports
Sports Injury Management: Volume I
lateral malleolus Pain, tenderness and swelling may also be seen over the tendon behind the rectinaculum Te rst choice o management or a peroneal subluxation is a reerral to physiotherapy or rehabilitation In acute stages, the aim is to prevent urther aggravation to the strain on the rectinaculum and a cast might be used or the rst 4-6 weeks During that period, gentle stretching o the tendon and range o movement is advised to prevent stiening o the ankle an kle Ultrasound and cryotherapy may also be used to help manage the pain and swelling i present Following the protective phase, proprioceptive training and eccentric strengthening exercises o the peroneal tendons are essential in prevention o a recurrence However, 50% o acute subluxation tends to recur in active athletes Tis would normally normally result in either surgery or a retirement rom the sport Tere are 3 common surgical techniques: • Rectinaculum Repair
• Groove Reconstruction • Construction o o a bony block Following surgery, physiotherapy will be essential to get you back to sport
Post-surgical Management An immobilization period varying rom 3-6 weeks will ollow aer surgery Upon removal o the cast, achieving a ull range o movement o your ankle will be the main goal o rehabilitation in the rst 4 weeks Pain controlling controlling modalities like ultrasound and ENS may be used i pain is present Building up the strength and proprioception o the ankle with exercises like cal raises and single leg stand (eyes open/ eyes closed) would normally start about the same time Progressing proprioceptive training rom standing on stable ground to a rocker board, ollowed by a wobble board is a normal progression beore proceeding proceeding to agility drills Only when one achieves ull range o movement, good strength and ability to complete sports specic agility drills will one be allowed to return to sports
Back2Sports - Shoulder and Knee Injury Specialists wwwBack2Sportscomsg
